Indications and methods for performance of osteoplastic-obliterative frontal sinusotomy with a description of a new method and some remarks upon the present state of the are of external frontal sinus surgery.

The Goodale-Montgomery osteoplastic obliterative frontal sinusotomy has been the ultimate resource in America for the most difficult and intractable cases of frontal sinusitis. This operation respects the integrity of the frontal floor and is based upon a concept with which the author disagrees: that the frontal sinus may be treated as an entity quite separate form the ethmoid. Macbeth, who does not obliterate, avails himself of the excellent transfrontal approach to the ethmosphenoids, but breaches the frontal floor in so doing. American surgeons have not followed his lead. The pros and cons of obliteration are discussed, reviewing relevant clinical and experimental data. The author believes that Macbeth's operation is more rational and effective than Goodale's. In an effort to utilize it and have the benefits of an obliterative technique, he employs a composite fat-fascia lata graft which prevents prolapse of fat down into nose and ethmoid. Three cases are briefly reported.